Ralph DiClemente
Ralph DiClemente
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Professor of Social and Behavioral Sciences
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Professional overview
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Dr. Ralph DiClemente was trained as a Health Psychologist at the University of California, San Francisco where he received his PhD in 1984 after completing a ScM at the Harvard School of Public Health. He earned his undergraduate degree at the City University of New York.
Dr. DiClemente’s research has four key foci:
- Developing interventions to reduce the risk of HIV/STD among vulnerable populations
- Developing interventions to enhance vaccine uptake among high-risk adolescents and women, such as HPV and influenza vaccine
- Developing implementation science interventions to enhance the uptake, adoption and sustainability of HIV/STD prevention programs in the community
- Developing diabetes screening and behavior change interventions to identify people with diabetes who are unaware of their disease status as well as reduce the risk of diabetes among vulnerable populations.
He has focused on developing intervention packages that blend community and technology-based approaches that are designed to optimize program effectiveness and enhance programmatic sustainability.
Dr. DiClemente is the author of ten CDC-defined, evidence-based interventions for adolescents and young African-American women and men. He is the author of more than 540 peer-review publications, 150 book chapters, and 21 books. He serves as a member of the Office of AIDS Research Advisory Council.
Previously, Dr. DiClemente served as the Charles Howard Candler Professor of Public Health at the Rollins School of Public Health at Emory University. He was also Associate Director of the Center for AIDS Research, and was previously Chair of the Department of Behavioral Sciences and Health Education at the Rollins School of Public Health.
Dr. DiClemente is Past President of the Georgia chapter of the Society for Adolescent Health & Medicine. He previously served as a member of the CDC Board of Scientific Counselors, and the NIMH Advisory Council.
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Education
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BA, The City College of the City University of New York (CCNY), New York, NYScM, Behavioral Sciences, Harvard University, Cambridge, MAPhD, Health Psychology, University of California San Francisco Center for Behavioral Sciences, San Francisco, CAPostdoctoral Fellow, University of California, San Francisco, CA
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Areas of research and study
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Community InterventionsDiabetesHIV/AIDSImplementation scienceInfluenzaPsychology
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Publications
Publications
A brief, clinic-based, safer sex intervention for heterosexual African American men newly diagnosed with an STD : a randomized controlled trial.
AbstractCrosby, R., DiClemente, R., Charnigo, R., Snow, G., & Troutman, A. (n.d.).Publication year
2009Journal title
American journal of public healthVolume
99 Suppl 1Page(s)
S96-103AbstractOBJECTIVE: We evaluated the efficacy of a brief, clinic-based, safer sex program administered by a lay health adviser for young heterosexual African American men newly diagnosed with a sexually transmitted disease (STD). METHODS: Subsequent to STD diagnosis, eligible men (N = 266; aged 18-29 years) were randomized to either a personalized, single-session intervention (delivered by a lay health adviser) or standard of care. We conducted behavioral assessments at baseline and 3 months postintervention (retention was 74.1%). We also conducted a 6-month clinic record review. RESULTS: Compared to men randomized to the control condition, those receiving the intervention were significantly less likely to acquire subsequent STDs (50.4% vs 31.9%; P = .002) and more likely to report using condoms during last sexual intercourse (72.4% vs 53.9%; P = .008). They also reported fewer sexual partners (mean 2.06 vs 4.15; P < .001) and fewer acts of unprotected sex (mean 12.3 vs 29.4; P = .045). Based on a 9-point rating scale, men in the intervention group had higher proficiency scores for condom application skills (mean difference = 3.17; P < .001). CONCLUSION: A brief clinic-based intervention delivered by a lay health adviser may be an efficacious strategy to reduce incident STDs among young heterosexual African American men.A decade in review : Building on the experiences of past adolescent STI/HIV interventions to optimise future prevention efforts
AbstractDiClemente, R., Sales, J. M., Milhausen, R. R., & DiClemente, R. J. (n.d.).Publication year
2006Journal title
Sexually transmitted infectionsVolume
82Issue
6Page(s)
431-436AbstractThe major purpose of this article is to systematically review and synthesise empirical findings from selected adolescent STI/HIV interventions conducted in the United States between 1994 and 2004. Specifically, the most current adolescent STI risk reduction interventions conducted in diverse venues, such as in the community, schools, clinics, and specialised adolescent centres (that is, detention homes and drug programmes) were examined for reported efficacy, and were assessed for programmatic and methodological strengths and weaknesses. Next, a subset of programmatic characteristics was identified that were associated with the efficacy of STI risk reduction programmes both within a particular venue, as well as across all venues. Finally, we discuss the research and practice implications of these findings for optimising future evidence based STI risk reduction programmes for adolescents in the United States.A descriptive analysis of STD prevalence among urban pregnant african-american teens : Data from a pilot study
AbstractDiClemente, R., Wingood, G. M., Crosby, R. A., Rose, E., Lang, D., Pillay, A., Papp, J., & Faushy, C. (n.d.).Publication year
2004Journal title
Journal of Adolescent HealthVolume
34Issue
5Page(s)
376-383AbstractObjective To assess the prevalence of sexually transmitted diseases (STDs) among a sample of African-American adolescent females at the time of their first prenatal visit and to assess key characteristics of those testing positive for sexually transmitted diseases. The study also determined differences in these characteristics between adolescents who were and those who were not diagnosed with an STD. Methods One-hundred-and-seventy pregnant African-American adolescents (aged 14-20 years; mean = 17.5 years) receiving their first prenatal visit were recruited at a prenatal clinic located in a large urban hospital. Biological assessment included nucleic acid amplification testing for gonococcal, chlamydial, and trichomonal infections. Rapid plasma reagin testing assessed infection with syphilis. A self-administered survey and in-depth face-to-face interview were used to collect detailed information assessing adolescents' sociodemographic characteristics, psychosocial indices, and their recent sexual risk behaviors. Data were analyzed using Student's t-tests and contingency table analyses, respectively, for continuous and categorical variables. Results Overall, 23.5% tested positive for one of the four STDs. Thirteen percent were infected with Chlamydia trachomatis, 1.2% with Neisseria gonorrhoeae, 8.9% with Trichomonas vaginalis, and 1.2% with Treponema pallidum. More than one-half reported recent (past 6 months) treatment for an STD, 30% of these tested positive for at least one of the four STDs assessed. Adolescents testing positive for STDs held favorable attitudes toward condom use, but levels of sexual risk were generally high. There were no sociodemographic, psychosocial, and sexual-risk differences between those testing positive and negative. Conclusion Findings support STD screening efforts targeting pregnant adolescents. Providing clinic-based counseling and prevention education programs to pregnant adolescents regardless of apparent risk factors may also be warranted.A longitudinal examination of risk and protective factors associated with drug use and unsafe sex among young African American females
AbstractVoisin, D. R., Hotton, A. L., Tan, K., & DiClemente, R. (n.d.).Publication year
2013Journal title
Children and Youth Services ReviewVolume
35Issue
9Page(s)
1440-1446AbstractThis study prospectively examined associations among multiple theoretically informed risk (e.g., depression, sexual sensation seeking, and risky peers norms) and protective factors (e.g., social support, STI knowledge, and refusal to have sex self efficacy) on unsafe sex among 715 African American adolescent females aged 15-21 who participated in an STI/HIV prevention intervention. Generalized estimating equation models were used to assess associations between baseline characteristics and sexual risk over a 12-month follow-up period. Overall risk in this population was high: at baseline, nearly a third of women reported sex under the influence of alcohol or substances; ≥ 2 partners for vaginal sex, and casual sex partners in the 60. days prior to baseline, and nearly 75% of those reporting vaginal sex used condoms inconsistently. In multivariable analysis, when risk and protective factors were simultaneously considered, higher levels of sexual sensation seeking were associated with having multiple sex partners and inconsistent condom use. Greater perception of risky peer norms was associated with a higher risk of having sex under the influence of alcohol or drugs. In addition, higher sex refusal self-efficacy was protective against having multiple; casual; and concurrent sex partners. Incorporating these salient factors into prevention programs may be critical to the development of targeted interventions for this population.A longitudinal examination of sexually transmitted infection/HIV prevention knowledge and sexually transmitted infections among African-American adolescent females
AbstractVoisin, D. R., Tan, K., & DiClemente, R. (n.d.).Publication year
2013Journal title
Journal of health psychologyVolume
18Issue
12Page(s)
1582-1587AbstractThis study examines whether sexually transmitted infection prevention knowledge predicts the acquisition of biologically confirmed sexually transmitted infections among African-American adolescent females. A total of 715 females were recruited from public health clinics in Atlanta, Georgia, and using audio computer-assisted self-interview technology, we assessed for demographics, sexually transmitted infection prevention knowledge, risky sexual behaviors, and sexually transmitted infections. After controlling for demographics and prior risky sexual behaviors, participants with high prevention knowledge were 0.09 times less likely to report sexually transmitted infections, and those with multiple sexual partners were 1.3 times more likely to report sexually transmitted infections. Our findings suggest that the promotion of accurate sexually transmitted prevention knowledge is critical especially among females with multiple sex partners.A longitudinal examination of the relationship between sexual sensation seeking and STI-related risk factors among African American females
AbstractVoisin, D. R., Tan, K., & DiClemente, R. (n.d.).Publication year
2013Journal title
AIDS Education and PreventionVolume
25Issue
2Page(s)
124-134AbstractSexual sensation seeking has been correlated with STI-related risk factors in numerous cross sectional studies. However, no current studies have examined whether sexual sensation seeking is longitudinally related to a broad spectrum of STI-related factors such as consistent condom use, number of sexual partners, frequency of partner sexual communication, self-efficacy to refuse sex, and fear of condom negotiation. We explored these relationships over a 12-month period among a sample of 715 African American females attending three STI clinics in Georgia that were recruited into a larger randomized clinic intervention study. Utilizing A-CASI technology to assess all self-reported measures and employing general estimation equations while controlling for age, peer norms, school enrollment and employment, major results indicated that higher sexual sensation seeking predicted lower percent of condom use in the last 14 and 60 days, lower consistent condom use and a higher number of lifetime sexual partners. Additionally, higher sexual sensation seeking predicted lower partner sexual communication, diminished self-efficacy to refuse sex, and a higher fear of condom negotiation. Findings suggest that STI/HIV prevention/intervention programs should assess for and target sexual sensation seeking behaviors in such efforts.A model for rigorously applying the Exploration, Preparation, Implementation, Sustainment (EPIS) framework in the design and measurement of a large scale collaborative multi-site study
AbstractBecan, J. E., Bartkowski, J. P., Knight, D. K., Wiley, T. R., DiClemente, R., Ducharme, L., Welsh, W. N., Bowser, D., McCollister, K., Hiller, M., Spaulding, A. C., Flynn, P. M., Swartzendruber, A., Dickson, M. F., Fisher, J. H., & Aarons, G. A. (n.d.).Publication year
2018Journal title
Health and JusticeVolume
6Issue
1AbstractBackground: This paper describes the means by which a United States National Institute on Drug Abuse (NIDA)-funded cooperative, Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), utilized an established implementation science framework in conducting a multi-site, multi-research center implementation intervention initiative. The initiative aimed to bolster the ability of juvenile justice agencies to address unmet client needs related to substance use while enhancing inter-organizational relationships between juvenile justice and local behavioral health partners. Methods: The EPIS (Exploration, Preparation, Implementation, Sustainment) framework was selected and utilized as the guiding model from inception through project completion; including the mapping of implementation strategies to EPIS stages, articulation of research questions, and selection, content, and timing of measurement protocols. Among other key developments, the project led to a reconceptualization of its governing implementation science framework into cyclical form as the EPIS Wheel. The EPIS Wheel is more consistent with rapid-cycle testing principles and permits researchers to track both progressive and recursive movement through EPIS. Moreover, because this randomized controlled trial was predicated on a bundled strategy method, JJ-TRIALS was designed to rigorously test progress through the EPIS stages as promoted by facilitation of data-driven decision making principles. The project extended EPIS by (1) elucidating the role and nature of recursive activity in promoting change (yielding the circular EPIS Wheel), (2) by expanding the applicability of the EPIS framework beyond a single evidence-based practice (EBP) to address varying process improvement efforts (representing varying EBPs), and (3) by disentangling outcome measures of progression through EPIS stages from the a priori established study timeline. Discussion: The utilization of EPIS in JJ-TRIALS provides a model for practical and applied use of implementation frameworks in real-world settings that span outer service system and inner organizational contexts in improving care for vulnerable populations. Trial registration: NCT02672150. Retrospectively registered on 22 January 2016.A Multi-Stage Dyadic Qualitative Analysis to Disentangle How Dietary Behaviors of Asian American Young Adults are Influenced by Family
AbstractAli, S. H., Cai, J., Kamal, F., Auer, S., Yang, K., Parikh, R. S., Parekh, N., Islam, N. S., Merdjanoff, A. A., & DiClemente, R. (n.d.).Publication year
2023Journal title
Behavioral MedicineAbstractThe dietary behaviors of Asian American (AA) young adults, who face a growing non-communicable disease burden, are impacted by complex socio-ecological forces. Family plays a crucial role in the lifestyle behaviors of AA young adults; however, little is known on the methods, contributors, and impact of familial dietary influence. This study aims to deconstruct the mechanisms of AA young adult familial dietary influence through a multi-perspective qualitative assessment. A five-phase method of dyadic analysis adapted from past research was employed to extract nuanced insights from dyadic interviews with AA young adults and family members, and ground findings in behavioral theory (the Social Cognitive Theory, SCT). 37 interviews were conducted: 18 young adults, comprising 10 different AA ethnic subgroups, and 19 family members (10 parents, 9 siblings). Participants described dietary influences that were both active (facilitating, shaping, and restricting) and passive (e.g., sharing foods or environment, mirroring food behaviors). Influences connected strongly with multiple SCT constructs (e.g., behavioral capacity, reinforcements for active influences, and expectations, observational learning for passive influences). Familial influence contributed to changes in the total amount, variety, and healthfulness of foods consumed. Intra-family dynamics were crucial; family members often leveraged each other’s persuasiveness or food skills to collaboratively influence diet. AA family-based interventions should consider incorporating both passive and active forms of dietary influence within a family unit, involve multiple family members, and allow for individualization to the unique dynamics and dietary behaviors within each family unit.A multi-stage dyadic qualitative analysis to disentangle how dietary behaviors of Asian American young adults are influenced by family
AbstractDiClemente, R., & Ali, S. (n.d.).Publication year
2024Volume
Behavioral MedicineAbstract~A multi-stage dyadic qualitative analysis to disentangle how family members influence the dietary behaviors of Asian American young adults
AbstractDiClemente, R., Ali, S., Cai, J., Kamal, F., Auer, S., Yang, K., Parikh, R., Parekh, N., & Islam, N. (n.d.).Publication year
2024Volume
Behavioral MedicineAbstract~A Multigroup, Longitudinal Study of Truant Youths, Marijuana Use, Depression, and STD-Associated Sexual Risk Behavior
AbstractDembo, R., Krupa, J. M., Wareham, J., Schmeidler, J., & DiClemente, R. (n.d.).Publication year
2017Journal title
Journal of Child and Adolescent Substance AbuseVolume
26Issue
3Page(s)
192-204AbstractTruant youths are likely to engage in a number of problem behaviors, including sexual risky behaviors. Previous research involving non-truant youths has found sexual risk behaviors to be related to marijuana use and depression, with differential effects for male and female youths. Using data collected in a National Institute on Drug Abuse (NIDA)-funded, prospective intervention project, results are reported of a male-female, multi-group, longitudinal analysis of the relationships among truant youth baseline sexual risk behavior, marijuana use, and depression, and their sexual risk behavior over four follow-up time points. Results indicated support for the longitudinal model, with female truants having higher depression scores, and showing stronger relationships between baseline depression and future engagement in sexual risk behavior, than male truants. Findings suggest that incorporating strategies to reduce depression and marijuana use may decrease youth sexual risk behavior.A multilevel intervention with African American churches to enhance adoption of point-of-care HIV and diabetes testing, 2014-2018
AbstractWingood, G. M., Lambert, D., Renfro, T., Ali, M., & DiClemente, R. (n.d.).Publication year
2019Journal title
American journal of public healthVolume
109Page(s)
S141-S144AbstractWe describe a multilevel intervention to enhance adoption of point-of-care HIV and diabetes testing at church health fairs in Atlanta, Georgia. Church leaders viewed a leadership video and subsequently conducted social activities that support testing. After the multilevel intervention, a third of churches hosted HIV and diabetes health fairs, and church leaders engaged in more social activities. Of 193 attendees receiving health services, 56.6% received HIV testing and 92.7% received diabetes testing. This implementation science approach could reduce HIV and diabetes disparities among African Americans.A network-individual-resource model for HIV prevention
AbstractJohnson, B. T., Redding, C. A., DiClemente, R., Mustanski, B. S., Dodge, B., Sheeran, P., Warren, M. R., Zimmerman, R. S., Fisher, W. A., Conner, M. T., Carey, M. P., Fisher, J. D., Stall, R. D., & Fishbein, M. (n.d.).Publication year
2010Journal title
AIDS and BehaviorVolume
14Issue
SUPPL. 2Page(s)
S204-S221AbstractHIV is transmitted through dyadic exchanges of individuals linked in transitory or permanent networks of varying sizes. A theoretical perspective that bridges key individual level elements with important network elements can be a complementary foundation for developing and implementing HIV interventions with outcomes that are more sustainable over time and have greater dissemination potential. Toward that end, we introduce a Network-Individual-Resource (NIR) model for HIV prevention that recognizes how exchanges of resources between individuals and their networks underlies and sustains HIV-risk behaviors. Individual behavior change for HIV prevention, then, may be dependent on increasing the supportiveness of that individual's relevant networks for such change. Among other implications, an NIR model predicts that the success of prevention efforts depends on whether the prevention efforts (1) prompt behavior changes that can be sustained by the resources the individual or their networks possess; (2) meet individual and network needs and are consistent with the individual's current situation/developmental stage; (3) are trusted and valued; and (4) target high HIV-prevalence networks.A new paradigm for optimizing HIV intervention synergy : The role of interdependence in integrating HIV prevention interventions
AbstractWingood, G. M., Rubtsova, A., DiClemente, R., Metzger, D., & Blank, M. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Issue
SUPPL. 1Page(s)
S108-S113Abstract~A Pilot Study of Sexual Communication and Negotiation Among Young African American Women : Implications for HIV Prevention
AbstractWingood, G. M., Hunter-Gamble, D., & DiClemente, R. (n.d.).Publication year
1993Journal title
Journal of Black PsychologyVolume
19Issue
2Page(s)
190-203AbstractRecent epidemiological studies indicate that African American female adolescents are at a markedly higher riskfor diagnoses with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) than their White female counterparts. Although epidemiologic data are informatve with respect to monitoring the course of the epidemic and quantifying the differential riskfor AIDSIHIV infection among young Afican American women in relation to other populations, they provide less insight into the influence of the diverse cultural, gender, andpsychosocial determinants ofHIV-associated risk behaviors. Afactor ofparticular importance is communication between sexual partners about condom use. Focus groups were conducted with African American women aged 18 to 25, to explore the process ofsexual communication and barriers toward sexual negotiation of condom use. HlVprevention programs tailored to African American women should emphasize training in sexual negotiation, conflict resolution, and refusal skills.A Pilot Study to Adapt a Trauma-Informed, Mindfulness-Based Yoga Intervention for Justice-Involved Youth
AbstractOwen-Smith, A., Black, H., Emerson, D., Cotner, M., Smith, H., Jackson, D., Ford, J. D., DeBar, L., DiClemente, R., & Hayat, M. J. (n.d.).Publication year
2021Journal title
International journal of yoga therapyVolume
31Issue
1AbstractThe purpose of the present study was to adapt and pilot a trauma-informed, mindfulness-based yoga (TIMBY) intervention focused on enhancing self-regulation among youth in the Georgia Department of Juvenile Justice system. In this article we (1) describe the process by which we systematically adapted an evidence-based protocol specifically for this population, (2) describe the nature of and rationale for those adaptations, (3) present some preliminary qualitative findings based on interviews with youth participants, and (4) briefly summarize how the adapted protocol will be evaluated in the subsequent feasibility trial. The iterative drafting and revision process involved modifications to a well-established, protocolized Trauma-Informed Yoga program and was identified by the project advisory board and t h rough formal interviews with intervention staff. Qualitative interviews were conducted with youth participants concerning intervention impact, credibility, and satisfaction. Several needed modifications were identified so that the intervention would be contextually appropriate for justice-involved youth. Thirty youth were enrolled in the pilot study: 77% we re Non - Hispanic Black/African-American, 18% were Non-Hispanic White, and 5% were Hispanic White. The average age was 16.45 years (range 14-20). The youth consistently reported satisfaction with the sessions and positive beliefs about how the sessions were helping them with a range of physical and psychological/ emotional challenges. Adaptations to the protocol in the present study highlight how mindfulness-based interventions for justice-involved youth need to consider what is both developmentally suitable for youth and appropriate in a justice setting. A feasibility study using this revised TIMBY protocol is underway at four Georgia Department of Juvenile Justice facilities to formally identify the barriers and facilitators to implementation for the present study and a future, larger-scale trial.A programmatic and methodologic review and synthesis of clinic-based risk-reduction interventions for sexually transmitted infections : Research and practice implications
AbstractDiClemente, R., Milhausen, R., McDermott Sales, J., Salazar, L. F., & Crosby, R. A. (n.d.).Publication year
2005Journal title
Seminars in Pediatric Infectious DiseasesVolume
16Issue
3Page(s)
199-218AbstractThe overarching goal of this article is to systematically review and synthesize empirical findings for sexually transmitted disease risk-reduction programs that were developed and implemented specifically for adolescents seeking health care services at clinical venues. The objective is to examine the reported efficacy of these programs in reducing adolescents' sexually transmitted infection (STI)-associated behavior, in enhancing theoretically and empirically important psychosocial mediators associated with the adoption of STI-preventive behaviors, and, most important, in reducing adolescents' risk of acquiring an STI. In addition, our review assesses program and methodologic characteristics of the studies, determines compliance with standardized reporting guidelines, identifies a subset of program characteristics that are related to efficacy in terms of modifying adolescents' sexual risk behaviors, and examines the research and practice implications of these findings for implementing evidence-based STI risk-reduction programs in clinics.A prospective study of exposure to rap music videos and African American female adolescents' health
AbstractWingood, G. M., DiClemente, R., Bernhardt, J. M., Harrington, K., Davies, S. L., Robillard, A., & Hook, E. W. (n.d.).Publication year
2003Journal title
American journal of public healthVolume
93Issue
3Page(s)
437-439Abstract~A prospective study of psychological distress and sexual risk behavior among black adolescent females.
AbstractDiClemente, R., DiClemente, R. J., Wingood, G. M., Crosby, R. A., Sionean, C., Brown, L. K., Rothbaum, B., Zimand, E., Cobb, B. K., Harrington, K., & Davies, S. (n.d.).Publication year
2001Journal title
PediatricsVolume
108Issue
5Page(s)
E85AbstractOBJECTIVE: The purpose of the study was to examine the association between adolescents' psychological distress and their sexually transmitted disease/human immunodeficiency virus (STD/HIV)-associated sexual behaviors and attitudes. METHOD: Sexually active black adolescent females (N = 522) completed, at baseline and again 6 months later, a self-administered questionnaire that assessed sexual health attitudes and emotional distress symptoms (using standardized measures, alpha =.84), a structured interview that assessed STD/HIV-associated sexual risk behaviors, and a urine screen for pregnancy. RESULTS: In multivariate analyses, controlling for observed covariates, adolescents with significant distress at baseline were more likely than their peers, after 6 months, to be pregnant (adjusted odds ratio [AOR]: = 2.0), have had unprotected vaginal sex (AOR = 2.1), have nonmonogamous sex partners (AOR = 1.7), and not use any form of contraception (AOR = 1.5). Additionally, they were also more likely to: perceive barriers to condom use (AOR = 2.2), be fearful of the adverse consequences of negotiating condom use (AOR = 2.0), perceive less control in their relationship (AOR = 2.0), have experienced dating violence (AOR = 2.4), feel less efficacious in negotiating condom use with a new sex partner (AOR = 1.6), and have norms nonsupportive of a healthy sexual relationship (AOR = 1.7). DISCUSSION: The findings suggest that psychological distress is predictive over a 6-month period of a spectrum of STD/HIV-associated sexual behaviors and high-risk attitudes. Brief screening to detect distress or depressive symptoms among adolescent females can alert the clinician to the need to conduct a sexual health history, initiate STD/HIV-preventive counseling, and refer for comprehensive psychological assessment and appropriate treatment. Among adolescents receiving STD treatment, those with even moderate emotional distress may be at heightened risk for further unhealthy outcomes. STD/HIV interventions should also consider psychological distress as one potential risk factor that may impact program efficacy.A qualitative case study examining intervention tailoring for minorities
AbstractMier, N., Ory, M. G., Toobert, D. J., Smith, M. L., Osuna, D., McKay, J. R., Villarreal, E. K., DiClemente, R., & Rimer, B. K. (n.d.).Publication year
2010Journal title
American Journal of Health BehaviorVolume
34Issue
6Page(s)
822-832AbstractObjectives: To explore issues of intervention tailoring for ethnic minorities based on information and experiences shared by researchers affiliated with the Health Maintenance Consortium (HMC). Methods: A qualitative case study methodology was used with the administration of a survey (n=17 principal investigators) and follow-up telephone interviews. Descriptive and content analyses were conducted, and a synthesis of the findings was developed. Results: A majority of the HMC projects used individual tailoring strategies regardless of the ethnic background of participants. Followup interview findings indicated that key considerations in the process of intervention tailoring for minorities included formative research; individually oriented adaptations; and intervention components that were congruent with participants' demographics, cultural norms, and social context. Conclusions: Future research should examine the extent to which culturally tailoring long-term maintenance interventions for ethnic minorities is efficacious and should be pursued as an effective methodology to reduce health disparities.A randomized controlled trial of a culturally congruent intervention to increase condom use and HIV testing among heterosexually active immigrant latino men
AbstractRhodes, S. D., McCoy, T. P., Vissman, A. T., DiClemente, R., Duck, S., Hergenrather, K. C., Foley, K. L., Alonzo, J., Bloom, F. R., & Eng, E. (n.d.).Publication year
2011Journal title
AIDS and BehaviorVolume
15Issue
8Page(s)
1764-1775AbstractThis randomized controlled trial tested the efficacy of an HIV prevention intervention to increase condom use and HIV testing among Spanish-speaking, heterosexually active immigrant Latino men. A community- based participatory research partnership developed the intervention and selected the study design. Following baseline data collection, 142 immigrant Latino men were randomized to the HIV prevention intervention or the cancer education intervention. Three-month follow-up data were collected from 139 participants, for a 98% retention rate. Mean age of participants was 31.6 years and 60% reported being from Mexico. Adjusting for baseline behaviors, relative to their peers in the cancer education comparison, participants in the HIV prevention intervention were more likely to report consistent condom use and receiving an HIV test. Community-based interventions for immigrant Latino men that are built on state of the art prevention science and developed in partnership with community members can greatly enhance preventive behaviors and may reduce HIV infection.A randomized controlled trial of an HIV prevention intervention for street-based female sex workers in Yerevan, Armenia : Preliminary evidence of efficacy
AbstractMarkosyan, K., Lang, D. L., Salazar, L. F., DiClemente, R., Hardin, J. W., Darbinyan, N., Joseph, J. B., & Khurshudyan, M. (n.d.).Publication year
2010Journal title
AIDS and BehaviorVolume
14Issue
3Page(s)
530-537AbstractThis study evaluated the efficacy of an HIV intervention among female sex workers (FSWs) randomized to an intervention or wait-list control. FSWs (N = 120) completed baseline, 3-and 6-month assessments. A health educator implemented 2-hour intervention emphasized gender-empowerment, self-efficacy to persuade clients to use condoms, condom application skills, and eroticizing safer sex. Over the 6-month follow-up, FSWs in the intervention reported more consistent condom use with clients (P =.004) and were more likely to apply condoms on clients (P =.0001). Intervention effects were observed for other psychosocial mediators of safer sex. Brief, gender and culturally congruent interventions can enhance HIV-preventive behaviors among FSWs.A Randomized Controlled Trial of an HIV Sexual Risk—Reduction Intervention for Young African-American Women
AbstractDiClemente, R., & Wingood, G. M. (n.d.).Publication year
1995Journal title
JAMA: The Journal of the American Medical AssociationVolume
274Issue
16Page(s)
1271-1276AbstractTo evaluate the efficacy of a community-based social skills human immunodeficiency virus (HIV) prevention intervention to enhance consistent condom use. —A randomized, single-blind controlled trial. —Bayview-Hunter's Point neighborhood of San Francisco, Calif, a predominantly African-American community that is economically disadvantaged. —A sample of 128 sexually active, heterosexual, African-American women 18 through 29 years of age was recruited using street outreach techniques. Participants completed a structured baseline interview; 100 women (78.1%) completed 3-month follow-up interviews. —Women randomized to the social skills intervention completed five sessions that emphasized ethnic and gender pride, HIV risk—reduction information, sexual self-control, sexual assertiveness and communication skills, proper condom use skills, and developing partner norms supportive of consistent condom use. Women randomized to the HIV education condition participated in a single session that provided HIV risk—reduction information. Women randomized to the delayed HIV education control condition received no HIV risk—reduction information until all follow-up interviews were completed. —Consistent condom use, HIV risk—reduction knowledge, sexual self-control, sexual assertiveness, sexual communication, and partner norms supportive of consistent condom use. —Compared with the delayed HIV education control condition, women in the social skills intervention demonstrated increased consistent condom use (adjusted odds ratio [OR], 2.1; 95% confidence interval [CI], 1.03 to 4.15; P=.04), greater sexual self-control (adjusted OR, 1.9; 95% CI, 1.00 to 3.60; P=.05), greater sexual communication (adjusted OR, 4.1; 95% CI, 1.67 to 10.01; P=.002), greater sexual assertiveness (adjusted OR, 1.8; 95% CI, 1.01 to 3.27; P=.05), and increased partners' adoption of norms supporting consistent condom use (adjusted OR, 2.1; 95% CI, 1.08 to 3.87; P=.03). No statistically significant differences in outcome variables were observed between the HIV education condition relative to the delayed HIV education control condition. —Community-based HIV risk—reduction programs that are gender relevant and culturally sensitive and provide social skills training can effectively enhance consistent condom use.A randomized controlled trial to reduce HIV transmission risk behaviors and sexually transmitted diseases among women living with HIV : The WiLLOW Program.
AbstractWingood, G. M., DiClemente, R., Mikhail, I., Lang, D. L., McCree, D. H., Davies, S. L., Hardin, J. W., Hook, E. W., & Saag, M. (n.d.).Publication year
2004Journal title
Journal of acquired immune deficiency syndromes (1999)Volume
37 Suppl 2Page(s)
S58-67AbstractOBJECTIVE: To evaluate the efficacy of an intervention to reduce HIV transmission risk behaviors and sexually transmitted diseases (STDs) and enhance HIV-preventive psychosocial and structural factors among women living with HIV. DESIGN: A randomized controlled trial of 366 women living with HIV in Alabama and Georgia. INTERVENTION: The intervention emphasized gender pride, maintaining current and identifying new network members, HIV transmission knowledge, communication and condom use skills, and healthy relationships. PRIMARY OUTCOME: Unprotected vaginal intercourse. OTHER OUTCOMES: Proportion never used condoms, incident STDs, psychosocial factors, and number of supportive network members. RESULTS: Over the 12-month follow-up, women in the WiLLOW intervention, relative to the comparison, reported fewer episodes of unprotected vaginal intercourse (1.8 vs. 2.5; P = 0.022); were less likely to report never using condoms (odds ratio [OR] = 0.27; P = 0.008); had a lower incidence of bacterial infections (Chlamydia and gonorrhea) (OR = 0.19; P = 0.006); reported greater HIV knowledge and condom use self-efficacy, more network members, fewer beliefs that condoms interfere with sex, and fewer partner-related barriers to condom use; and demonstrated greater skill in using condoms. CONCLUSION: This is the first trial to demonstrate reductions in risky sexual behavior and incident bacterial STDs and to enhance HIV-preventive psychosocial and structural factors among women living with HIV.A review of STD/HIV preventive interventions for adolescents : Sustaining effects using an ecological approach
AbstractDiClemente, R., Salazar, L. F., & Crosby, R. A. (n.d.).Publication year
2007Journal title
Journal of pediatric psychologyVolume
32Issue
8Page(s)
888-906AbstractObjective: Behavioral intervention programs to reduce adolescent sexual risk behaviors have shown statistically significant reductions in the short-term; however, longer-term follow-up has demonstrated that effects diminish. One criticism has been the reliance on individual-level models. We review the research that has shaped this narrow perspective and propose that a broader, ecological perspective is needed to amplify and extend the efficacy of sexual risk reduction interventions. Methods: We summarize adolescent sexual risk research and outline intervention research that is suggestive of an ecological perspective. Examples from the published literature that have investigated antecedents or conceptualized preventive interventions using a multilevel approach are provided. Results: Adolescents are exposed to diverse sources of influence transecting different levels of causation. To adequately prevent, reduce, and maintain the likelihood of adolescents' adopting sexual risk behaviors, intervention programs should be designed to address these myriad levels of causation. This approach has been implemented in Brazil and was shown to be effective. Conclusion: Research should cross manifold levels of causation so that programs will be more effective at promoting adolescents' adoption and maintenance of STD/HIV preventive behaviors.